DATE:
September 16, 2022
TO:
Senator Phil Berger and Speaker Tim Moore
FROM:
John Thompson, Vice President of State Government Relations
SUBJECT:
Certificate of Need Modifications
The North Carolina Healthcare Association voted unanimously on September 16, 2022 on the following items to advance Medicaid Expansion and the Healthcare Access and Stabilization Program (HASP). Medicaid expansion and HASP are vitally important for our state’s healthcare safety net. Additionally, Certificate of Need protections are important for our vulnerable systems. Weighing the priorities and previous conversations, the Board approved Certificate of Need modifications in order to advance passage of Expansion and HASP. 1. Full Medicaid Expansion using federally funded incentives to cover the portion of the state’s share at first and hospitals picking up the state’s share gradually over time. 2. HASP at the full allowable amount 3. Repeal CON for Chemical dependency beds 4. Repeal CON for Psychiatric beds 5. Exempt operating rooms from CON in ambulatory surgical centers who meet the following criteria: a. Be located in a county with a population over 125,000 per the Census except those counties with a Sole Community Designated Hospital b. Must participate in the charity care fund (4% of patient net revenue) c. Meet quality and patient safety standards, including: i. Have at least three specialties recognized by the American Board of Medical Specialties and perform at least 100 procedures of each specialty annually ii. Must have active transfer agreements with the nearest acute care hospital iii. 50% of the ASC’s credentialed physicians from each specialty must have admitting privileges with the nearest acute care hospital d. Participate in a 5% provider tax of net patient revenue to offset Expansion e. Not effective until five years after the go live date of HASP/Expansion (i.e. the first payments for HASP are received post Medicaid Expansion) 6. Direct the Secretary of DHHS to develop and administer a fund for at-risk independent or managed hospitals, with deposits from the HASP premium tax funds (approximately $60M) once HASP payments begin. This would be a rebrand of the Senate’s Rural Hospital Stabilization Fund. NCHA looks forward to working with Legislative leaders on these urgent items. Staff have draft legislation on these points that will be emailed separately.